This invention relates to a universal medication dosing system designed to aid in the practice of pediatric medicine. Medication dosing is simplified by the development of color-coded dosing zones based on patient weight or length, depending on the circumstances. When weights are readily available, such as in offices, clinics, or hospitals, weight is used as the universal dosing value. When weight is not available, the child's length can be used to determine his "color." Once the proper dosing "color" has been established, the color remains the same for all medication dosing so long as the child's weight or length remain with the range of weights or lengths applicable to that color.
Length-based dosing will often be more appropriate for emergencies where weight is frequently not known. This system can also be used for home dosing of medications where accurate weights are also usually not available. All patients within a given zone would be given the same dose range of medication.
The invention also has application for determination of other physical treatment values, such as the proper size of pediatric equipment, ventilator settings, infusion devices, etc. The zones would be labeled with the name of the color for use by those who are color blind.
In adult medicine the dosing of medications and selection of appropriately-sized equipment is straightforward. A cardiac arrest, for instance, can be treated by giving "an amp" of epinephrine or bicarbonate. Likewise the initial dose of atropine for an adult may be given as 0.5 mgs of atropine for bradycardia. This dosage may be given safely to a broad spectrum of patients. Similarly an adult with a fever can take two aspirins or two Tylenol tablets and feel comfortable that he has taken an appropriate dose. An adult patient can be intubated with one of only a few sizes of endotracheal tubes, and it is not difficult to learn which size tube to use based on experience in dealing with differently-sized adults. This is obviously not the case in pediatrics. Children's sizes vary tremendously from the smallest premature infant to a large pre-pubital child. There are more than ten endotracheal sizes that may be appropriate for different size pediatric patients. Medications are most commonly dosed according to patient weight and dosages are expressed in ranges of mgs/kg. To arrive at an appropriate dose one must know the patient's weight, the formula in mg./kg., and the concentrations of the drug which are available. Then, mathematical calculations must be done to arrive at the appropriate dosage. Using weight to dose becomes problematic in circumstances where weight is not known. This is true in emergency situations such as pediatric cardiac arrests, seizures, and trauma situations. In addition, it is quite difficult to remember formulas and do mathematical computations accurately in the excitement of a pediatric resuscitation. It may take even a seasoned clinician years to get used to the nuances of dosages and equipment sizes and equipment settings in children. Even with experience, few clinicians are really comfortable with giving children drugs such as IV sedatives, pain medications, paralyzing agents, to name only a few.
The everyday practice of pediatrics is constantly interrupted by the question of how much of a given drug should be given to a particular pediatric patient. Physicians such as orthopedists and surgeons spend a significant amount of time looking up dosages. Frequently sufficient time is not taken, or inadvertent mistakes are made, or the dosages are determined by educated guess, giving erratic and inconsistent dosages of many medications to children. In emergencies this problem is magnified because there may not be time to look up the dosage.
This also creates problems for nurses who are responsible for giving the proper dosage, yet may not have the time to verify an order under these circumstances. In addition, non-physicians may be called upon to dose children under emergency situations such as a paramedic treating a child who is seizing with IV or rectal Valium, or cardiac arrest. Even an emergency physician may feel uncomfortable with IV demerol for a child with a broken leg, in part due to concern about giving the proper dose to give pain relief without developing respiratory insufficiency. The resulting dilemma tends to lead to underutilization of pain medications and undue suffering to the pediatric patient.
This problem also impacts the field of medical education where each year there is an influx of first year residents who are called upon to dose children in hospitals and clinics. Unfortunately, even the best of childrens' hospitals and medical centers report their share of dosing mistakes, occasionally with tragic outcomes. This problem is not unique to the medical community. The lay public has great concerns about giving medications to children. Studies have shown that in the common scenario of a child with a fever, dosages of acetaminophen are frequently inadequate and ineffective, contributing to marked parental anxiety. Inadequate dosing may also contribute to unnecessary trips to emergency departments, since a fever that doesn't come down with antipyretics is a common reason for an ED visit. Deaths have been reported resulting from inadvertent overdosing of fever medication at home. Even physicians are concerned about how much of such seemingly innocuous agents as decongestants and cold preparations to give their own children or grandchildren. If they don't practice pediatrics, they may find themselves calling a colleague to ask how much Dimetapp to give their one year old child.
In addition, the FDA has been hesitant to give dosing information to the public for young children. The bottle label tells them to call their doctor for instructions. This is not, however, a practical solution to this problem since they may not have a doctor or he may be unavailable at that time. In addition, many people do not feel comfortable calling under those circumstances, and find themselves giving medication anyway, perhaps asking a grandmother how much, or just taking a guess at the amount.
This entire problem is compounded by the large number of people who are both professionally and personally called upon to give medications to children. At the top are pediatricians who are quite adept at dosing pediatric patients, except possibly in the area of pediatric emergencies. However, many other medical specialties are called upon to dose children and lack the expertise of pediatricians. At best it can be very time-consuming for physicians and nurses to find the proper dose. At worse, mistakes are made. In addition there are paramedics, nurse practitioners, physician's assistants, health department nurses, daycare center personnel, teachers and parents, all whom may be called upon to decide how much medication a child should take.
In the area of pediatric emergency medicine this problem has been previously addressed by the development of a tape measure, the Broselow Tape, which allows the dosage of medications and equipment sizes to be determined from a direct length measurement of the patient. The tape is disclosed in U.S. Pat. No. 4,713,888. This has been found to be useful since it makes unnecessary the estimation of weight in an emergency, memorization of infrequently used formulas and the necessity to do mathematical calculations under duress. The equipment zones on the Broselow tape are color-coded to allow storage and access of emergency equipment by color, allowing more rapid access and easier restocking. For these reasons, the Broselow tape is now well accepted and widely used.
This application relates to the development of a universal pediatric dosing system based on the concept of developing dosing zones not only for equipment but for drugs as well. These zones would be designed so that all children within the zone could be given the same dosage instructions specific for that drug. The dose could be a single fixed amount such as for liquid Tylenol, or could be a range for titrating IV medications such as demerol or Versed. For example, assume that a child presents to an emergency department with a painful fracture. His color could be obtained from a Broselow tape while lying on the stretcher. If he were in the "blue" zone, he would be given the "blue dose" of demerol. The "blue dose might say "give 10 mgs of Demerol IV every 3 to 5 minutes until pain relieved." If the child were to become unduly sedated, he could be given the "blue dose" of Narcan. It seems likely that a child would more readily be given pain medications if dosing were not an issue.
A similar example could be given for a child who needs sedation for a CT scan. It would be a simple matter for the radiologist to order an appropriate dose without having to confer with the hospital pharmacy or a pediatrician. Surgery procedures could also be indexed by the dosing color. For instance, the procedures could be identified as "three blue cases and two red cases this morning in surgery."
This would allow the drugs and equipment for each case to be prepared prior to surgery. The pre-op medications and pain medications as well as anesthetics would all be indexed to this color. The maintenance fluids during surgery could be given by setting the infuser to the proper color. The simplest way the system could be implemented would be the addition of a colored dosage page to each chart. On that page would be written commonly used pediatric drugs in the proper dose for a patient of that dosage color. It could be used as a single reference for all the health care providers dealing with that patient. It would have both elective and emergency drugs calculated for that patient. It could also incorporate maximal doses of potentially toxic drugs and thus used as a "failsafe" mechanism for those drugs. The color could also be incorporated into the actual dosing vehicle such as color-coded syringes. These syringes can be particularly useful in the area of pre-hospital treatment of pediatric emergencies. Likewise, the colors could be incorporated into dosing devices for the public such as color-coded cups, syringes, etc. for use with OTC medications. The system would always be available to the clinician if he desired to use it. However, it could be overridden at all times. If the physician did decide to use other methods to arrive at dosages, the color-code would still allow the nurse administering the drug to quickly check a reference before giving the medication if she were unsure of the proper dosage for that patient. In other words it could function as a "failsafe" mechanism for dosing children.
For instance, the pharmacy of the hospital could put a "rainbow label" on each medication. It would consist of the name of the medication, the concentration and the eight dosing colors. Within each color would be written the dose in the appropriate number of cc's. At the beside the nurse would check the patient's arm band to determine his color and then check the rainbow label of the medication to make sure that the dosage ordered was appropriate. If she had brought another patient's medication by mistake, she would probably be warned there night be an error since the dose would typically be incorrect. In the pre-hospital arena the color would function like a "vital sign." A first responder could call the color of a sick or injured child into central dispatch. The color would help the system anticipate the child's drug, fluid and equipment needs. In addition, it would help the system prepare for the probable etiologies of the problem. For instance acute respiratory distress in a "blue" would have different probable causes than in a "pink." One further advantage of the color-coded dosing system is that it can become the vehicle for disseminating EMS-C and Safe Kids concepts into the daily practice of medicine. The simplicity of the system should encourage both the public and professionals to turn to color-coded sources for dosing information. Injury and accident instructions as well as aftercare instructions could all be related to the child's "color." It would help people focus on the different needs of children of different sizes in a simple and visually graphic way. By incorporating injury and accident prevention information into these materials, they would serve as an important reminder to health care professionals to reinforce these important messages with each patient encounter. When one looks at the tremendous variety of situations in which children are given medications, color coding is an effective way of enhancing reliability, safety and efficacy.